Common Questions About Carotid Stenting for Stroke Prevention

Who is Predisposed to Carotid Artery Stenosis?

Carotid artery stenosis is also known as carotid artery disease. It's a major cause of ischemic stroke and caused by plaque formation in the carotid arteries. Understanding the risk factors can help you determine if you need to be screened for carotid artery stenosis, which can then be treated with a stent before it causes a stroke. Risk factors include:

• Age. Carotid artery disease is more common in people over 50.
• Hypertension
• Type 2 diabetes
• High cholesterol
• Smoking
• Drinking
• Family history of carotid artery stenosis
• High fat diet
• Lack of exercise
• Obesity

People with these risk factors should be screened.

Indications for Carotid Stenting: When Do You Need It?

Carotid stending is typically indicated if you have 70% plus blockage but no symptoms, or if you have symptoms. It is less invasive than carotid endartectomy, which involves exposing the artery and removal of plaque, so is commonly recommended for people at high surgical risk.

Not sure whether carotid stenting is the right treatment for you? Before deciding on any procedure, it is important to understand how carotid artery disease is assessed and when intervention may be recommended. Visit our Carotid Artery Disease Decision-Making Guide to learn about symptoms, diagnosis, treatment options, and specialist evaluation.

Recognizing Symptoms of Carotid Artery Stenosis and Impending Stroke

Because most people aren't screened, you need to understand and recognize potential symptoms of carotid artery stenosis. Typically there are no specific symptoms of carotid artery stenosis until a Transient Ischemic Attack (TIA, a mini stroke) or stroke occurs.

The following symptoms should be considered a medical emergency:

• Temporary loss of or blurring of vision
• Slurred or unclear speech
• Loss of feeling in the face, arm, or leg
• Confusion and difficulty concentrating
• Sudden onset headache
• Dizziness or fainting
• Loss of movement or coordination
• Paralysis of an arm or leg on one side.
• Weakness or clumsiness of an arm or leg on one side.

In a TIA, symptoms go away entirely within 24 hours, with the attack itself lasting between a few minutes and an hour. If the symptoms don't go away, it's a stroke. However, you should seek medical attention even if symptoms disappear, as a TIA may be a warning sign of a stroke and there are often things doctors can do to prevent stroke or further TIAs.

Diagnosis: How Carotid Artery Stenosis is Detected

Because carotid artery stenosis has no specific symptoms, it has to be detected through screening. Screening may be done if you have risk factors and is routine after a TIA or a stroke while establising a cause.

Diagnosis is done via ultrasound imaging of your neck to take images of the carotid artery and branches. These images show the extent of plaque build up and how badly the artery has been blocked, and help indicate whether it is the cause of the TIA.

The Carotid Artery Stenting Procedure: What To Expect

Carotid artery stenting is most often done under local anesthesia, with optional sedation, because the doctor needs to monitor your neurological status. A stent is either inserted into the femoral artery in the groin and moved through the body or inserted directly into the carotid artery itself. Not everyone is a candidate for transcarotid stenting as it depends on the conformation of your carotid artery.

The procedure usually takes from 30 minutes to 2 hours and most people have to stay in the hospital for a day or two. You may be requested to stop certain medications and should stop smoking for a week or two beforehand.

Post-Stenting Recovery: Rehabilitation and Monitoring

Most people have femoral stenting, with the catheter inserted through the groin. If this is the case, you should avoid stairs as much as possible for the first two to three days, and not drive, do yard work or similar heavy chores, or play sports. These restrictions can often be lifted after 2 days.

You will need to change the bandage on your dressing and keep an eye on it. If the incision bleeds or swells, lie down and put pressure on it for 30 minutes. If it doesn't stop, go to the ER. Some patients are asked to take aspirin or clopidogrel for a period of time to reduce the risk of clots forming in the stent. Downtime, however, is minimal.

Follow-up Care

Plaque build up can recur after stenting and in some cases get worse. You should make lifestyle changes such as improving your diet, exercising as you can, and reducing stress. You should stop smoking - if this is a problem for you, talk to your doctor about a cessation program. Limit your consumption of alcohol.

When to Consider a Carotid Stenting Specialist Assessment

Carotid artery narrowing may not always cause symptoms, but it can increase the risk of stroke if left untreated in higher-risk situations. A specialist assessment helps determine the severity of the narrowing, understand your stroke risk and identify whether carotid stenting or another treatment approach may be appropriate.

Consider arranging a specialist assessment if you:

• Have been diagnosed with carotid artery stenosis or narrowing.
• Have experienced a transient ischaemic attack (TIA) or stroke symptoms.
• Have sudden weakness, numbness, speech difficulties or vision changes that may indicate reduced blood flow to the brain.
• Have been advised that you may need carotid artery surgery or intervention.
• Want to understand whether minimally invasive carotid stenting is suitable for you.
• Would like a second opinion regarding your stroke prevention treatment options.
• Have risk factors such as high cholesterol, high blood pressure, diabetes or smoking history.

At the Supreme Vascular and Interventional Clinic, assessment includes a comprehensive review of your symptoms, medical history and vascular imaging. Your specialist will evaluate the severity and characteristics of your carotid artery disease, explain your treatment options and recommend a personalised approach based on your individual stroke risk.

Through specialist-led care and minimally invasive techniques, patients receive guidance throughout their journey — from diagnosis and treatment planning through follow-up and long-term stroke prevention.

Seek emergency medical attention immediately if you experience sudden facial drooping, weakness or numbness on one side of the body, difficulty speaking, sudden vision loss, severe dizziness or loss of coordination, as these may indicate a stroke.

Other Minimally Invasive Stroke Treatment Options in Singapore

Stenting is generally the easiest and least invasive treatment for carotid artery disease. Other minimally invasive options include intracranial stenting (which is used for people with recurring stroke symptoms), mechanical thrombectomy, and lifestyle changes that can help prevent strokes or prevent them from recurring.

At Supreme Vascular and Interventional Clinic we have the expertise to treat your carotid artery disease and lower your risk of having a stroke. Stenting is the least invasive treatment method and the one we most often recommend for carotid issues. If you have been diagnosed with carotid artery stenosis or have risk factors, contact us to make an appointment today with our stroke specialist, Dr. Manish Taneja.

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We've Got You Covered for Specialized Stroke Screening, Prevention, and Management

Imagine heart attacks where the blood flow to your heart is blocked. Similarly, a stroke occurs when the blood flow to your brain is interrupted becoming a "brain attack". When blood supply does not reach a certain part, brain cells begin to die. Different types of stroke include ischemic strokes (blockage of blood vessel due to blood clot) or a mini stroke, a TIA (transient ischemic attack), with no permanent damage yet serious. Stroke also occurs when a blood vessel in the brain pops causing bleeding in the brain.

When a stroke occurs, the symptoms of stroke depend on how blood flow to the brain is affected. Individuals at high risk and even higher risk (family history) often have high blood pressure, atrial fibrillation, or another risk factor for stroke, all of which increase the risk of stroke.  Disrupted blood flow can  even damage the blood vessel in the brain and affect one side of the body. Having a stroke doesn’t mean it has to lead to permanent disabilities. Recognizing early warning signs is essential to reduce the risk, and in some cases, procedures such as carotid endarterectomy may help increase the blood vessel in the brain and restore healthy circulation.

Certain areas of the brain can be affected by stroke and some symptoms of a stroke including cardiovascular disease, diabetes, and high blood sugar levels increase the risk of stroke whereas an active lifestyle or controlling high cholesterol reduces the risk. How well do you know stroke? Find tips to prevent and manage stroke, the differences in stroke screening tests, and the newer technology and treatments available. Come in for an easy consultation and further evaluation with our stroke specialist in Singapore at the Supreme Vascular and Interventional Clinic. 

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The Supreme Vascular and Interventional Clinic is your "go-to" facility for various neurointerventional / stroke conditions and treatments. To arrange an appointment with Dr. Manish Taneja, our stroke specialist, contact us. You can also call us at (+65) 6904 8084 for a consultation.